Biosynthetic implant for soft tissue repair

ABSTRACT

An implant and a process for preparing such an implant are disclosed. The implant includes a porous layer including collagen, a non-porous layer including a collagenic constituent, and a reinforcement component. The non-porous layer is joined to the porous layer and the reinforcement member is embedded into the non-porous layer. The porous layer has a three dimensional density ranging from about 20 mg collagen/cm 3  to about 200 mg collagen/cm 3 .

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.12/492,827 filed Jun. 26, 2009, which claims benefit of and priority toU.S. Provisional Application No. 61/076,166 filed Jun. 27, 2008, andU.S. Provisional Application No. 61/076,164 filed Jun. 27, 2008, and thedisclosures of each of the above-identified applications are herebyincorporated by reference in their entirety.

TECHNICAL FIELD

The present composite materials or implants have at least, a non-porouslayer, a porous layer and a reinforcement member. The present compositematerials or implants resist tearing when used in surgery, cansimultaneously achieve hemostasis and prevent post-surgical adhesionwherever it is needed. They are particularly indicated for complexhernia, requiring resistance to microbial infection and a low speed ofdegradation during implantation. The present composite materials resisttearing when used in orthopedic surgery for tendon or ligament repair.They can support the repair/regeneration of soft tissues, under highstress/load.

DESCRIPTION OF THE RELATED ART

Implants for use in visceral surgery having a porous adhesive collagenlayer closely associated with a collagen film are known. In this type ofmaterial, the film helps prevent the formation of post-operativeadhesions and the porous adhesive collagen layer functions as ahemostatic compress.

Such implants are frequently secured to tissue during surgery using asurgical fastener, such as a staple, clip, tack, suture or the like.Collagen, however, weakens quickly when exposed to the moist conditionswithin the body during surgery. As a result, previous composite implantsare prone to tearing during implantation.

In addition, the strength of such implants typically is too low for useunder the high stresses or high loads encountered in orthopedic surgery,such as in tendon or ligament repair.

It would be advantageous to provide an implant having anti-adhesion,antimicrobial and relatively high strength properties and which resiststearing when subjected to the forces associated with securing theimplant to tissue using surgical fasteners.

It would be advantageous to provide an implant having anti-adhesion,hemostatic and antimicrobial properties and which resists tearing whensubjected to the forces associated with securing the implant to tissueusing surgical fasteners.

In particular, it would be advantageous to provide an implant whichmaintains its properties, such as integrity, strength, resistance totearing, porosity, thickness, when it is submitted to moist or wettedconditions, such as conditions encountered after implantation, when theimplant is surrounded by biological fluids. It would also beadvantageous to provide an implant which, although bioabsorbable in thelong term (i.e., over one year), is long lasting, i.e., maintains itsproperties and integrity for at least 6 months.

SUMMARY

The present implants therefore aim to considerably improve thepreviously described composite collagenic materials with respect totheir handling characteristics and resistance to tearing duringimplantation, their time of full degradation (over 1 year), theirability to withstand high loads and their resistance to microbialcontamination during implantation, in particular when they are submittedto moist conditions such as implantation conditions, when they aresurrounded by biological fluids. These aims are achieved by the presentimplants which include at least a non-porous layer, a porous layer and areinforcement member. In embodiments, the non-porous layer is anoxidized collagen constituent-containing film possessing anti-adhesionproperties. In embodiments, the porous layer is a collagen-containingfoam that provides a matrix for soft tissue repair and/or regeneration,and that is long lasting and maintains its properties and integrity evenin a wetted state. In embodiments, the reinforcement member is a mesh,such as a mesh having a weight density of below about 50 g/m². In otherembodiments, the reinforcement member is a mesh, such as a mesh having aweight density of greater than about 100 g/m². The mesh, which can beknitted either from biodegradable yarns, non biodegradable yarns or anycombination of thereof, may be fully coated with a collagen basedformulation so as to limit the inflammation reaction and the infectionrisk associated with the yarns of the mesh. In other embodiments, themesh is coated by any materials which can reduce the inflammationreaction and the infection risk.

Methods for producing the present implants are also described. Inembodiments, the reinforcement member is fully coated with cross-linkedcollagens. Then a liquid solution based on oxidized collagen destined toform the non-porous layer is cast on a substrate. The coatedreinforcement member is applied to the solution, in embodiments becomingcompletely embedded therein, for example, by pressing the reinforcementmember into the solution or by the application of additional solution ontop of the original volume of solution. Prior to complete gelling, apre-formed porous layer, made from long lasting collagenic formulationis laid on the surface of the gelling solution. Upon drying, the variouscomponents adhere to form the present implant.

One aspect of the present disclosure is an implant comprising:

-   -   a porous layer comprising at least a collagen,    -   a non-porous layer comprising a collagenic constituent, the        non-porous layer being joined to the porous layer, and    -   a reinforcement member,    -   wherein the reinforcement member is embedded into the non-porous        layer, and the porous layer has a three dimensional density        ranging from about 20 mg collagen/cm³ to about 200 mg        collagen/cm³.

According to the present application, the three dimensional density incollagen of the porous layer is measured as follows: the amount ofcollagen used for the preparation of the porous layer is initiallyweighed in mg and recorded. The dimensions, i.e., length, width andthickness, of the porous layer in the final product, either in a dry orwetted state, are measured in cm. As meant in the present application, awetted state corresponds to the soaking of the porous layer, or of theimplant, during 24 hours in water at ambient temperature (i.e., 18-25°C.). The three dimensional density of the porous layer in mgcollagen/cm³ results from the ratio of the amount weighed in mg over thevolume measured in cm³.

The porous layer of the implant of the present disclosure has a threedimensional density ranging from about 20 mg collagen/cm³ to about 200mg collagen/cm³, either in a dry or wetted state. As a consequence, theporous layer of the implant of the present disclosure has a threedimensional density ranging from about 20 mg collagen/cm³ to about 200mg collagen/cm³, in a dry state. Also, the porous layer of the implantof the present disclosure has a three dimensional density ranging fromabout 20 mg collagen/cm³ to about 200 mg collagen/cm³ in a wetted state,i.e., after soaking in water at ambient temperature (18-25° C.) during24 hours. The porous layer of the implant of the present disclosure istherefore dense in collagen, i.e., it comprises a high ratio ofcollagen. Such a density allows the porous layer to be long lastingalthough the porous layer will degrade in vivo in the long term, i.e.,over one year for example. For example, the porous layer of the implantof the present disclosure will not be degraded before 6 months after theimplantation. At the same time, the porous layer of the implant of thepresent disclosure shows a good homogeneity and favors the cellulargrowth. In particular, the porous layer of the implant of the presentdisclosure maintains its properties, such as integrity, porosity,resistance to tearing, strength, thickness, even in moist conditions,i.e., in a wetted state, similar to the conditions of implantation, whenthe porous layer and/or the implant is surrounded by the biologicalfluids. In particular, the porous layer of the implant of the presentdisclosure maintains substantially its thickness after implantation: forexample there is no increase of 50% of the thickness or decrease of twothirds of the thickness of the porous layer after immersion of theporous layer in water, i.e., in moist conditions similar to theimplantation moist conditions.

In an embodiment, the three dimensional density ranges from about 50 mgcollagen/cm³ to about 150 mg collagen/cm³.

In embodiments, the collagen of the porous layer comprises at leastoxidized collagen.

In embodiments, the collagen of the porous layer further comprises acollagen crosslinked with a compound selected from glutaraldehyde,hexamethylene diisocyanate (HMDI) and mixtures thereof. For example, thecompound is glutaraldehyde. Alternatively, the compound is hexamethylenediisocyanate.

In embodiments, the porous layer further comprises a chitosan.

In embodiments, the collagenic constituent of the non-porous layer isoxidized collagen.

In embodiments, the reinforcement member is a mesh having a weightdensity less than 100 g/m², for example less than 50 g/m². In suchembodiments, in particular, the mesh may be isoelastic. By “isoelastic”is meant according to the present application that the mesh showssubstantially similar elastic properties in all directions. Such meshesare particularly suitable for implants of the present disclosureintended to be used as reinforcement implants for hernia repair forexample.

In other embodiments, the reinforcement member is a mesh having a weightdensity greater than 50 g/m², for example greater than 100 g/m². In suchembodiments, in particular, the mesh may be asymmetric. By “asymmetric”is meant in the present application that the mesh shows significantlydifferent elastic properties in at least two different directions, forexample in two perpendicular directions. Such meshes are particularlysuitable for implants of the present disclosure intended to be used asreinforcement implants for tendon and/or ligament repair for example.

In embodiments, the mesh may be coated with a collagen crosslinked witha compound selected from glutaraldehyde, hexamethylene diisocyanate(HMDI) and mixtures thereof.

In other embodiments, the mesh may be coated with a mixture of oxidizedcollagen and chitosan.

In embodiments, the implant comprises an additional non-porous layer.The additional non-porous layer may have the same composition or adifferent composition from the non-porous layer above. The additionalnon-porous layer may comprise an additional reinforcement memberembedded therein. The additional reinforcement member may be identicalto or different from the reinforcement member above.

In embodiments, the porous layer is biodegradable. By biodegradable ismeant herein that all the components forming the porous layer will becompletely degraded in vivo after a certain amount of time. The porouslayer of the implant of the present disclosure is long lasting andtherefore will not be completely degraded in vivo before 6 months afterimplantation.

Another aspect of the present disclosure is a process for preparing animplant having a porous layer, a non-porous layer, and a reinforcementmember comprising the steps of:

-   -   a) Preparing a composition comprising at least a collagen, using        purified fibers of collagen as starting material,    -   b) Freeze drying the composition of a) to obtain a porous layer,    -   c) Compressing the porous layer obtained in b) so as to obtain a        three dimensional density ranging from about 20 mg collagen/cm³        to about 200 mg collagen/cm³,    -   d) Pouring a solution of a collagenic constituent onto a support        to obtain a non-porous layer,    -   e) Applying a reinforcement member on a top surface of the        non-porous layer obtained in d), and    -   f) Applying the compressed porous layer obtained in c) on the        top surface of the non-porous layer, during gelification of the        non-porous layer.

The starting material used for obtaining the porous layer of the processof the present disclosure is purified fibers of collagen. Such purifiedfibers of collagen are obtained by conventional techniques such asdescribed in FR-A-2 715 309. For example, the collagen is extracted fromporcine dermis by solubilization at acidic pH or by digestion withpepsin, and purified by saline precipitations according to knowntechniques (see for example FR-A-2 715 309). Dry collagen fibers arethen obtained by precipitation of an acid solution of such a collagen byadding NaCl, and then washing and drying of the precipitate obtainedwith aqueous solutions of acetone.

Using purified fibers of collagen for preparing the porous layer of theimplant of the present disclosure allows determining exactly the contentof collagen in the resulting porous layer of the final product.

In embodiments, the porous layer is compressed in step c) so as toobtain a three dimensional density ranging from about 50 mg collagen/cm³to about 150 mg collagen/cm³.

In embodiments, the collagen of the porous layer comprises at leastoxidized collagen.

In embodiments, the collagen of the porous layer further comprises acollagen crosslinked with a compound selected from glutaraldehyde,hexamethylene diisocyanate (HMDI) and mixtures thereof.

In embodiments, the collagen of the porous layer further comprises achitosan.

In embodiments, the collagenic constituent of the non-porous layer isobtained from purified fibers of collagen used as starting material.

In embodiments, in step e), the reinforcement member is pressed into thesolution of the non-porous layer, without causing significant disruptionof the portion of the layer of solution in contact with the support, soas to embed the reinforcement member completely within the non-porouslayer.

Alternatively, in step e), following application of the reinforcementmember, additional solution of the collagenic constituent of step d) maybe applied in an amount sufficient to cover the reinforcement member, soas to embed the reinforcement member completely within the non-porouslayer.In embodiments, in step c), the porous layer is compressed so as toreduce its thickness from about 1.2 times to 5 times. For example, theporous layer obtained in c) has a thickness ranging from about 0.1 cm to1.5 cm.

Another aspect of the present disclosure is an implant obtainable by aprocess as described above.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1-3 are schematic illustrations of composite materials inaccordance with embodiments of the present disclosure;

FIG. 4 shows a knitting pattern suitable for making a mesh reinforcementmember for use in embodiments described herein;

FIG. 5 is a schematic representation of a composite material inaccordance with another embodiment of the present disclosure;

FIG. 6 is a schematic representation of a composite material inaccordance with another embodiment of the present disclosure;

FIGS. 7-9 show illustrative knitting patterns suitable for use in makingreinforcement components that may be incorporated into compositematerials in accordance with embodiments of the present disclosure; and

FIG. 10 is a schematic representation of an implanted implant inaccordance with the present disclosure in a rat.

DETAILED DESCRIPTION

The present implants include one or more non-porous layers, a porouslayer and one or more reinforcement members. As seen in FIG. 1,composite implant 10 includes non-porous layer 20, porous layer 30 andreinforcement members 40, which in this illustrative embodiment aremultifilament yarns coated with coating 45 and embedded withinnon-porous layer 20. Each of these components and processes forpreparing each component and the composite implant are described ingreater detail below.

In the embodiment shown in FIG. 2, composite implant 110 includesnon-porous layer 120, porous layer 130 and reinforcement members 140which in this illustrative embodiment are multifilament yarns coatedwith coating 145 and embedded within non-porous layer 120. In theembodiment shown in FIG. 3, composite implant 210 includes non-porouslayers 220 and 250, porous layer 230 and reinforcement member 240 withcoating 245, which in this illustrative embodiment is embedded withinnon-porous layers 220.

In the embodiment shown in FIG. 5, composite implant 210 includesnon-porous layers 220 and 250, porous layer 230 and reinforcementmembers 240 and 260 coated with a coating 265, which in thisillustrative embodiment are embedded within non-porous layers 220 and250, respectively. In the embodiment shown in FIG. 6, composite implant310 includes non-porous layers 320 and 350, porous layer 330 andreinforcement members 340 with coating 345, and 360 with coating 365,which in this illustrative embodiment are embedded within non-porouslayers 320 and 350, respectively.

Each of these components and processes for preparing each component andthe composite implant are described in greater detail below.

The Non-Porous Layer

The one or more non-porous layers may retard or prevent tissue ingrowthfrom surrounding tissues thereby acting as an adhesion barrier andpreventing the formation of unwanted scar tissue. Thus, in embodiments,the one or more non-porous layers possesses anti-adhesion properties. By“non-porous layer” is meant according to the present application a layerhaving a surface substantially closed to all potential cellular growth,such as a film.

The one or more non-porous layers may be as well a physical barrieragainst microbial contamination.

The one or more (for example additional) non-porous layers of thepresent implant may be made from any biocompatible natural or syntheticmaterial. The material from which each non-porous layer is formed may bethe same or different and may be bioabsorbable or non-bioabsorbable. Itshould of course be understood that any combination of natural,synthetic, bioabsorbable and non-bioabsorbable materials may be used toform the one or more non-porous layers. Techniques for formingnon-porous layers from such materials are within the purview of thoseskilled in the art and include, for example, casting, molding and thelike.

Some non-limiting examples of materials from which a non-porous layermay be made include but are not limited to poly(lactic acid),poly(glycolic acid), poly(hydroxybutyrate), poly(phosphazine),polyesters, polyethylene glycols, polyethylene oxides, polyacrylamides,polyhydroxyethylmethylacrylate, polyvinylpyrrolidone, polyvinylalcohols, polyacrylic acid, polyacetate, polycaprolactone,polypropylene, aliphatic polyesters, glycerols, poly(amino acids),copoly(ether-esters), polyalkylene oxalates, polyamides,poly(iminocarbonates), polyalkylene oxalates, polyoxaesters,polyorthoesters, polyphosphazenes and copolymers, block copolymers,homopolymers, blends and combinations thereof.

In embodiments, natural biological polymers are used in forming the oneor more non-porous layers of the implant. Suitable natural biologicalpolymers include, but are not limited to, collagen, gelatin, fibrin,fibrinogen, elastin, keratin, albumin, hydroxyethyl cellulose,cellulose, oxidized cellulose, hydroxypropyl cellulose, carboxyethylcellulose, carboxymethyl cellulose, and combinations thereof. Inaddition, the natural biological polymers may be combined with any ofthe other polymeric materials described herein to produce a non-porouslayer of the implant.

In embodiments, the non-porous layer of the implant comprises at least acollagenic constituent.

In such embodiments, an aqueous solution of a collagenic constituent maybe used to form a non-porous layer of the present implants. As usedherein, the term “collagenic constituent” designates collagen which hasat least partially lost its helical structure through heating or anyother method, or gelatine. The term “gelatine” here includes commercialgelatine made of collagen which has been denatured by heating and inwhich the chains are at least partially hydrolyzed (molecular weightlower than 100 kDa). The collagenic constituent used may advantageouslybe formed of non-hydrolyzed collagen, mainly composed of a chains(molecular weight around 100 kDa). In the context of the presentdisclosure, a chains means complete a chains or fragments of thesecomplete a chains produced by the loss of a small number of amino acids.The term “non-hydrolyzed” as used herein means that less than 10% of thecollagenic chains have a molecular weight below about 100 kDa. Ifheating is used to denature the helical structure of the collagen, theheating should be moderate and provided under gentle conditions so as toavoid degradation by hydrolytic cleavage of the gelatine thus formed.Suitable gelatine materials are commercially available.

The collagen used can be of human or animal origin. It may particularlybe type I porcine or bovine collagen, or type I or type III humancollagen or mixtures in any proportions of the last two types. Nativecollagen may advantageously be used, in acid solution or afterprocessing, to eliminate the telopeptides, notably by pepsin digestion.The collagen can also be oxidized: in such a case, the collagen may bemodified by oxidative cleavage using any technique know to those skilledin the art, including, but not limited to the use of periodic acid orone of its salts as described by Tardy et al. in U.S. Pat. No.4,931,546, the entire content of which is herein incorporated byreference. Briefly, this technique involves mixing the collagen in acidsolution with a solution of periodic acid or one of its salts at aconcentration of between about 1 and 10⁻⁵ M, in embodiments betweenabout 5 10⁻³ and 10⁻¹ M, at a temperature of between about 10 and 25° C.for about 10 minutes to 72 hours. This process breaks down hydroxylysineand the sugars of the collagen, thus creating reactive sites withoutcausing crosslinking. The oxidative cleavage of collagen allows moderatecross-linking later in the collagenic material. It should of course beunderstood that this function may be provided by other means of moderatecross-linking, for example by beta or gamma irradiation, or other agentsof moderate cross-linking, for example chemical reagents at suitably lowand non-toxic doses.

In embodiments, at least one of the non-porous layers of the presentimplant is made from collagen modified by oxidative cleavage asdescribed above. In other embodiments, the extent of collagencross-linking can be increased by any techniques known to those skilledin the art to adjust the degradation time of the non-porous layer asdesired. As used herein, the term “moderately crosslinked” means thatthe degradation of the non-porous layer will be at least 90% complete(as measured by residual weight) by the end of about three weeks ofimplantation; the term “highly crosslinked” means that the degradationof the non-porous layer will be at least 90% complete (as measured byresidual weight) by the end of about three months of implantation; andthe term “extremely highly crosslinked” means that the degradation ofthe non-porous layer will be at least 90% complete (as measured byresidual weight) by the end of about two years of implantation.

In embodiments, the collagen is advantageously formed of non-hydrolyzedcollagen, mainly composed of a chains (molecular weight around 100 kDa).In the context of the present disclosure, a chains means complete achains or fragments of these complete a chains produced by the loss of asmall number of amino acids. The term “non-hydrolyzed” as used hereinmeans that less than 10% of the collagenic chains have a molecularweight below about 100 kDa. If heating is used to denature the helicalstructure of the collagen, the heating should be moderate and providedunder gentle conditions so as to avoid degradation by hydrolyticcleavage of the gelatine thus formed.

In embodiments, the collagenic constituent is oxidized collagen.

In such embodiments, a solution of oxidized collagen as defined abovemay be used to form the non-porous layer. Typically, a collagenconcentration from about 5 g/l to about 50 g/l, in embodiments fromabout 25 g/l to about 35 g/l is used.

The solution of oxidized collagen may be heated, for example to atemperature in excess of 37° C., in embodiments to a temperature of fromabout 40° C. to about 50° C., for at least one hour. This results in atleast partial denaturing of the collagen's helical structure. Otherphysical or chemical techniques for denaturing collagen (e.g.,ultrasonication, or by the addition of chaotropic agents) are within thepurview of those skilled in the art may also be used.

In embodiments, the collagenic constituent of the non-porous layer isobtained from purified fibers of collagen used as starting material.Such purified fibers of collagen are obtained as described below for theporous layer.

In embodiments, at least one macromolecular hydrophilic additive that ischemically unreactive with the collagenic constituent may be added tothe solution used to form the non-porous layer. “Chemically unreactivewith the collagenic constituent” as used herein means a hydrophiliccompound which is not likely to react with the collagenic constituent,notably which does not form covalent bonds with it during cross-linking.

The macromolecular hydrophilic additive advantageously has a molecularweight in excess of 3,000 Daltons, in embodiments from about 3,000 toabout 20,000 Daltons. Illustrative examples of suitable macromolecularhydrophilic additives include polyalkylene glycols (such as polyethyleneglycol), polysaccharides (e.g., starch, dextran and/or cellulose),oxidized polysaccharides, and mucopolysaccharides. It should of coursebe understood that combinations of macromolecular hydrophilic additivesmay be used. In embodiments, polyethyleneglycol 4000 (4000 correspondingto the molecular weight) is added as the macromolecular hydrophilicadditive. The concentration of hydrophilic additive(s) can typically befrom about 2 to about 10 times less than that of the collagenicconstituent. Typically, the macromolecular hydrophilic additive iseliminated by diffusion through the non-porous layer, in a few days.

Optionally, glycerine may be added to the solution used to form thenon-porous layer. When present, the concentration of glycerine in thesolution can typically be from about 2 to about 10 times less than thatof the collagenic constituent, in embodiments less than about one-thirdof the collagenic constituent concentration.

In illustrative embodiments of the solution used to form the non-porouslayer, the concentrations of collagenic constituent, hydrophilicadditive(s) and glycerine, when present, can be from about 2% to about10% for the collagenic constituent, from about 0.6% to about 4% for thehydrophilic additive(s) and from about 0.3% to about 2.5% for glycerine,respectively.

The solution used to form the non-porous layer may be prepared by addingcollagenic constituent, hydrophilic additive(s) and glycerine, whenpresent, to water or a water/alcohol (e.g., ethanol) mixture at atemperature of from about 30° C. to about 50° C. The solution mayadvantageously be neutralized to a neutral pH to avoid hydrolyzing thecollagenic constituent by heating and to obtain a film of physiologicalpH while permitting pre-cross-linking of the collagenic constituent ifthe mixture contains oxidized collagen as indicated previously.

The Porous Layer

The porous layer of the implant has a three dimensional density incollagen which may prevent or reduce the risk of microbial contaminationof the implant. By “porous layer” is meant according to the presentapplication a layer comprising pores, voids, holes allowing at leastsome cellular growth to take place.

The porous layer of the implant has for example openings or pores overat least a portion of a surface thereof. As described in more detailbelow, suitable materials for forming the porous layer include, but arenot limited to foams (e.g., open or closed cell foams). In embodiments,the pores may be in sufficient number and size so as to interconnectacross the entire thickness of the porous layer. In other embodiments,the pores do not interconnect across the entire thickness of the porouslayer. Closed cell foams are illustrative examples of structures inwhich the pores may not interconnect across the entire thickness of theporous layer. In yet other embodiments, the pores do not extend acrossthe entire thickness of the porous layer, but rather are present at aportion of the surface thereof. In embodiments, the openings or poresare located on a portion of the surface of the porous layer, with otherportions of the porous layer having a non-porous texture. Those skilledin the art reading the present disclosure will envision other poredistribution patterns and configurations for the porous layer.

The porous layer of the present implant may include any biocompatiblenatural or synthetic material. The material contained in the porouslayer may be bioabsorbable or non-bioabsorbable. It should of course beunderstood that any combination of natural, synthetic, bioabsorbable andnon-bioabsorbable materials may be used to form the porous layer. Somenon-limiting examples of materials from which the porous layer may bemade include but are not limited to poly(lactic acid), poly(glycolicacid), poly(hydroxybutyrate), poly(phosphazine), polyesters,polyethylene glycols, polyethylene oxides, polyacrylamides,polyhydroxyethylmethylacrylate, polyvinylpyrrolidone, polyvinylalcohols, polyacrylic acid, polyacetate, polycaprolactone,polypropylene, aliphatic polyesters, glycerols, poly(amino acids),copoly(ether-esters), polyalkylene oxalates, polyamides,poly(iminocarbonates), polyalkylene oxalates, polyoxaesters,polyorthoesters, polyphosphazenes and copolymers, block copolymers,homopolymers, blends and combinations thereof.

In embodiments, the porous layer comprises one or more bioabsorbable,natural biological polymer. Suitable natural biological polymersinclude, but are not limited to, collagen, gelatin, cellulose,hydroxypropyl cellulose, carboxyethyl cellulose, chitin, chitosan, andcombinations thereof. Alternatively, the polymer constituent may be apolysaccharide such as chitin or chitosan, or polysaccharides modifiedby oxidation of alcohol functions into carboxylic functions such asoxidized cellulose. In addition, the natural biological polymers may becombined with any biocompatible synthetic materials to produce theporous layer of the implant.

Where the porous layer is a foam, the porous layer may be formed usingany method suitable to forming a foam or sponge including, but notlimited to the lyophilization or freeze-drying of a composition.Suitable techniques for making foams are within the purview of thoseskilled in the art.

The porous layer can be at least about 0.1 cm thick, in embodiments fromabout 0.2 to about 1.5 cm thick. The porous layer can have a twodimensional density of not more than about 100 mg collagen/cm² and, inembodiments, from about 10 mg collagen/cm² to about 50 mg collagen/cm².The two dimensional density of the porous layer is calculated bydividing the three dimensional density obtained as explained above bythe thickness of the porous layer. The three dimensional density of theporous layer ranges from about 20 mg collagen/cm³ to about 200 mgcollagen/cm³, in embodiments from about 50 mg collagen/cm³ to about 150mg collagen/cm³, either in a dry state or a wetted state of the porouslayer The size of the pores in the porous layer can be from about 10 μmto about 500 μm, in embodiments from about 20 μm to about 200 μm.

Such a porous layer, in particular having a three dimensional densityranging from about 20 mg collagen/cm³ to about 200 mg collagen/cm³, inembodiments from about 50 mg collagen/cm³ to about 150 mg collagen/cm³,either in a dry or wetted state, is long lasting, i.e., it is notdegraded before 6 months after implantation. At the same time, theporous layer of the implant of the present disclosure shows a gooddistribution and interconnection of the pores, thereby allowing anexcellent cellular growth.

The porous layer of the implant of the present disclosure comprises atleast a collagen. By “collagen” is meant according to the presentapplication, a non-denatured collagen or collagen which has at leastpartially lost its helical structure through heating or any othermethod.

The starting material used for obtaining the porous layer of the processof the present disclosure is purified fibers of collagen. Such purifiedfibers of collagen are obtained by conventional techniques such asdescribed in FR-A-2 715 309. For example, the collagen is extracted fromporcine dermis by solubilization at acidic pH or by digestion withpepsin, and purified by saline precipitations according to knowntechniques (see for example FR-A-2 715 309). Dry collagen fibers arethen obtained by precipitation of an acid solution of such a collagen byadding NaCl, and then washing and drying of the precipitate obtainedwith aqueous solutions of acetone.

In embodiments, the porous layer is a made from non-denatured collagenor collagen which has at least partially lost its helical structurethrough heating or any other method, consisting mainly of non-hydrolyzeda chains, of molecular weight close to 100 kDa. The term “non-denaturedcollagen” means collagen which has not lost its helical structure. Thecollagen used for the porous layer of present implant may be nativecollagen or atelocollagen, notably as obtained through pepsin digestionand/or after moderate heating as defined previously. The origin and typeof collagen may be as indicated for the non-porous layer describedabove.

In embodiments, the collagen of the porous layer comprises at leastoxidized collagen. The oxidized collagen may be obtained as alreadydescribed above for the non-porous layer.

In embodiments, the collagen may be cured to any desired degree. As usedherein, the term “moderately cured” means that the degradation of theporous layer will be at least 90% complete (as measured by residualweight) by the end of about three weeks of implantation; the term“highly cured” means that the degradation of the porous layer will be atleast 90% complete (as measured by residual weight) by the end of aboutthree months of implantation; and the term “extremely highly cured”means that the degradation of the porous layer will be at least 90%complete (as measured by residual weight) by the end of about two yearsof implantation. In illustrative embodiments, moderately cured collagenis obtained by oxidative cleavage of collagen by periodic acid or one ofits salts, as described for collagens of the non-porous layer. Highlycured collagen is made from collagen cross-linked by glutaraldehyde orby any other know cross-linking agents such as isocyanates, for examplehexamethylene diisocyanate (HMDI). The degree of crosslinkingdistinguishes between highly cured and very highly cured materials.Techniques for curing to various degrees are within the purview of thoseskilled in the art.

In embodiments, the collagen of the porous layer further comprises acollagen crosslinked with a compound selected from glutaraldehyde,hexamethylene diisocyanate (HMDI) and mixtures thereof. For example, thecompound is glutaraldehyde. Alternatively, the compound is hexamethylenediisocyanate.

In embodiments, the porous layer further comprises a chitosan.

The porous layer of the implant of the present disclosure may beobtained by freeze drying a composition comprising at least a collagen,using purified fibers of collagen as starting material.

In embodiments, the porous layer can be obtained by freeze-drying anaqueous acid solution or suspension of collagen at a concentration ofabout 2 to about 100 g/l and an initial temperature of about 4° C. toabout 25° C. The concentration of collagen in the solution or suspensioncan be from about 10 g/l to about 100 g/l, in embodiments about 20 g/l.

The collagen suspension or solution can be made from non-cured,moderately cured, highly cured or extremely highly cured collagens orcombinations of thereof at any proportions. It may include as well noncollagenic components, such as glycosaminoglycans, among them chitosan.The glycosaminoglycans display a degree of acetylation (DA) of fromabout 0.5% to about 50%. They have a molecular weight ranging from about100 to about 1,000,000 g/ml. It displays also a low polydispersity indexof from about 1.2 to about 1.8. They may be a mixture of chitosans andother glycosaminoglycans (eg. hyaluronic acid), which have free aminogroups capable of cross-linking to the oxidized collagen. Inembodiments, the collagen suspension or solution is the combination ofoxidized collagen and chitosan which can form a cross-linked network. Asa result, in embodiments, the porous layer of the implant comprisesoxidized collagen and chitosan, for example forming a network.

The porous layer is advantageously neutralized before its freeze-dryingas a solution or suspension or after its freeze-drying under a dry form,at a pH from about 6 to about 8. In embodiments, the porous layer afterits freeze-drying may be further cross-linked by any known cross-linkingagents (e.g., glutaraldehyde, isocyanates) and/or by any physicaltreatment (e.g., thermal processing, gamma- and beta-irradiation).

The porous layer may be compressed so as to obtain a three dimensionaldensity ranging from about 20 mg collagen/cm³ to about 200 mgcollagen/cm³, for example ranging from about 50 mg collagen/cm³ to about150 mg collagen/cm³.

For example, the porous layer may be further packed down by any relevanttechniques so as to get a thickness from about 0.1 cm to about 1.5 cmand a 3D (three dimensional) density of from about 50 mg collagen/cm³ toabout 150 mg collagen/cm³. The porous layer may be compressed so as toreduce its thickness from about 1.2 times to 5 times.

In any case where the porous layer is packed down, it may be furtherstabilized by thermal treatment, in dry conditions, at a temperature upto about 100° C., for up to 2 days or by cross-linking with any knowncross-linking agents. In other embodiments, it may be further stabilizedby soaking the porous layer in a collagenic solution such as an oxidizedcollagen solution and by drying this solution. Agents in the collagensolution/suspension such as glycerin may be as well added, before thefreeze-drying, to stabilize the thickness of the porous layer.

In embodiments, the porous layer is biodegradable. By biodegradable ismeant herein that all the components forming the porous layer will becompletely degraded in vivo after a certain amount of time. The porouslayer of the implant of the present disclosure is long lasting andtherefore will not be completely degraded in vivo before 6 months afterimplantation.

The Reinforcement Member

The present implant also includes one or more reinforcement members. Thereinforcement member may be positioned entirely within the non-porouslayer.

The reinforcement member can be a mesh prepared using any techniqueknown to those skilled in the art, such as knitting, weaving, tatting,knipling or the like. Illustrative examples of suitable meshes includeany of those that are presently commercially available for herniarepair. In embodiments where a mesh is used as the reinforcement member,the mesh will aid in affixing the composite to tissue without tearing ofthe porous or non-porous layers.

It is envisioned that the reinforcement member may be formed from anybioabsorbable, non-bioabsorbable, natural, and synthetic materialpreviously described herein including derivatives, salts andcombinations thereof. In particularly useful embodiments, thereinforcement member may be made from a non-bioabsorbable material toprovide long term flexible tissue support. In embodiments, thereinforcement member is a surgical mesh made from polyester,polypropylene, poly(lactic acid) (PLA), poly(glycolic acid) (PGA),oxidized cellulose, polycaprolactone (PCL), polydiaxanone (PDO),trimethylene carbonate (TMC), polyvinyl alcohol (PVA),polyhydroxyalkanoates (PHAs), polyamides, polyethers, copolymers thereofand mixtures thereof. In addition polyethylene materials may also beincorporated into the implant described herein to add stiffness. Wheremonofilaments or multifilament braids are used as the reinforcementmember, any commercially available suture material may advantageously beemployed as the reinforcement member.

It is envisioned as well that the reinforcing member may be knitted frombioabsorbable yarns, non bioabsorbable yarns or both of them, in anycombination.

In embodiments, the mesh is a flat mesh, essentially a two dimensionalmesh, displaying a thickness lower than about 1 mm. The mesh may beisoelastic or asymmetric while displaying mechanical properties(stiffness, elasticity at physiological loads) close to the tissues tobe repaired and/or regenerated.

In embodiments, the mesh weight density is below about 100 g per m², inembodiments, below about 50 g per m². The weight density of the mesh isdetermined according to the following method: the weight of the mesh ismeasured in grams; this weight is divided by the surface of the mesh insquare meters. In such embodiments, the mesh may be isoelastic. Othercharacteristics which the reinforcement member may in embodimentsadvantageously possess include a breakage resistance of 100N minimum (asdetermined by ISO 13934-1) and an extension breakage of 20 to 40% under50N (as determined by ISO 13934-1). Suitable fabrics suitable forobtaining isoelastic meshes can be made on a Rachel or warp knittingmachine with at least two threading tools, one threaded full, one emptywith PLA, PET or PP monofilament or multifilament biocompatible threadsas shown in FIG. 4. When performed on a 22 or 24 gauge knitting machine,the macro-pores allow for a good integration to tissues. Such meshes areparticularly suitable for implants of the present disclosure intended torepair an abdominal wall, for hernia treatment for example.

In other embodiments, the mesh is asymmetric, with a longitudinal axisdisplaying the highest mechanical properties and corresponding to thelongitudinal axis of tendons and ligaments to be repaired.

In such embodiments, the ultimate load at break of the mesh in itslongitudinal axis is from about 100N to about 1,000N, in embodimentsover 250N (as determined by ISO 13934-1).

In such embodiments, the elongation at break of the mesh in itslongitudinal axis is less than about 100%, in embodiments less thanabout 20% (as determined by ISO 13934-1). The elongation at 100 N istypically from about 1% to about 20%, in embodiments from about 1% toabout 10% (as determined by ISO 13934-1).

The pores size of the mesh are from about 1 mm to 5 mm, in embodimentsfrom about 1 mm to 2.5 mm.

In embodiments, in particular when the mesh is asymmetric, the meshweight density is greater than about 50 g per m², in embodiments over100 g per m².

In embodiments, the mesh is designed in such a way that it can betrimmed to the size of the defect to be repaired without any significantloss of the initial strain.

In embodiments, the mesh needs to hold sutures with a pull out strengthof at least 100 N (as determined by ISO 13934-1).

In embodiments, the porosity of the mesh is from about 20% to about 98%,in embodiments from about 40% to about 95%. For the purpose of thepresent application, the porosity of a mesh is intended to mean aporosity measured in the following way: the dimensions, i.e., length,width and thickness, of the mesh, taken alone, are measured; moreover,the density of the yarns used to prepare the mesh is known. The mesh isweighed. By means of a simple subtraction, the volume occupied by theempty spaces within the mesh is deduced therefrom. The porosity over theentire mesh is determined as being the percentage of empty volumerelative to the total volume of the mesh.

In embodiments, a suitable two dimensional fabric for obtaining anasymmetric mesh is prepared on a Rachel or warp knitting machine withthree threading tool bars and a “marquisette” type weave, a bar forminga chain, two bars moving symmetrically as partial weft. (See FIG. 7) Thenumber of crossings “under” a needle of these two weft bars determinesthe height of the opening. The three bars are one threaded full, oneempty 22 or 24 gauge with standard thread or high tenacity thread countmini 150 dtex monofilament or mini 50 dtex multifilament.

In other embodiments, another suitable two dimensional mesh is obtainedwith three knitting bars one of which is threaded full, with the twodesign bars one full and one empty. (See FIG. 8.)

In yet other embodiments, another suitable two dimensional mesh isobtained with one full bar, one empty bar and two other one full andthree empty (See FIG. 9.).

Coating of the Reinforcement Member

In embodiments, the reinforcement member is coated, so as to cover atleast some of the surfaces of the reinforcement member. In embodiments,most of the accessible surfaces of the reinforcement member are covered.In some embodiments, the resulting coated reinforcement member mayappear partially or fully embedded in the coating formulation. It isenvisioned that the reinforcement member may be coated with anybioabsorbable, non-bioabsorbable, natural, and synthetic materialpreviously described.

In the embodiment shown in FIG. 2, composite implant 110 includesnon-porous layers 120, porous layer 130 and reinforcement members 140which in this illustrative embodiment are multifilament yarns coatedwith coating 145 and embedded within non-porous layer 120. Where tworeinforcement members are used, for example, a reinforcement member andan additional reinforcement member, each reinforcement member may becoated and the coating compositions may be the same or different on eachreinforcement member. It is also envisioned that where two reinforcementmembers are used, one may be coated and one may remain uncoated. In theembodiment shown in FIG. 5, for example, only reinforcement member 260includes a coating 265 while reinforcement member 240 is uncoated. Inthe embodiment shown in FIG. 6, composite implant 310 includesnon-porous layers 320 and 350, porous layer 330 and reinforcementmembers 340 with coating 345 and 360 with coating 365, which in thisillustrative embodiment are embedded within non-porous layers 320 and350, respectively.

In embodiments where the reinforcement member is a mesh, it may becoated with a collagenic coating by soaking the mesh once, twice, threetimes or more in a collagenic solution or suspension. The collagen canbe native collagen or gelatin, as described above. The collagen also maybe chemically modified, by oxidation, esterification (e.g., methylation,ethylation, succinylation) or the like. At the end of each soakingcycle, the collagen layer laid on the mesh may be further cross-linkedby any known cross-linking agents such as glutaraldehyde andisocyanates. Alternatively, the collagen is cross-linked once at the endof the overall soaking process.

Where the reinforcement member is a mesh, the soaking collagen solutionor suspension may include non collagenic components, such asglycosaminoglycans, among them chitosan, as described above inconnection with the porous layer. The coating may be made from oxidizedcollagen and chitosan. The layer of the collagenic solution orsuspension may be neutralized with an alkaline bath at the end of eachsoaking cycle or only once when the overall soaking process iscompleted.

In embodiments, the mesh is coated with a collagen crosslinked with acompound selected from glutaraldehyde, hexamethylene diisocyanate (HMDI)and mixtures thereof. In other embodiments, the mesh is coated with amixture of oxidized collagen and chitosan.

In some embodiments, where the reinforcing member is a mesh, the meshmay be pretreated by plasma or gas techniques for the formation of alayer containing bioactive agents such as antimicrobial agents (eg.DADMAC, Silver particles). For example, gas phase coating technologybased on siloxane chemistry may be applied to the surface of the meshwhere the siloxane thin film coating (<100 nm) material may includesilver particles as described in the U.S. Pat. No. 6,984,392 and EP1,691,606 B1.

Optional Bioactive Agents

In some embodiments, at least one bioactive agent may be combined withthe implant and/or any of the individual components (the porous layer,the one or more non-porous layers, the one or more reinforcement membersand/or the coating on the one or more reinforcement members) used toconstruct the implant. In these embodiments, the implant can also serveas a vehicle for delivery of the bioactive agent. The term “bioactiveagent”, as used herein, is used in its broadest sense and includes anysubstance or mixture of substances that have clinical use. Consequently,bioactive agents may or may not have pharmacological activity per se,e.g., a dye, or fragrance. Alternatively a bioactive agent could be anyagent which provides a therapeutic or prophylactic effect, a compoundthat affects or participates in tissue growth, cell growth, celldifferentiation, an anti-adhesive compound, a compound that may be ableto invoke a biological action such as an immune response, or could playany other role in one or more biological processes. It is envisionedthat the bioactive agent may be applied to the medical device in anysuitable form of matter, e.g., films, powders, liquids, gels and thelike.

Examples of classes of bioactive agents which may be utilized inaccordance with the present disclosure include anti-adhesives,antimicrobials, analgesics, antipyretics, anesthetics, antiepileptics,antihistamines, anti-inflammatories, cardiovascular drugs, diagnosticagents, sympathomimetics, cholinomimetics, antimuscarinics,antispasmodics, hormones, growth factors, muscle relaxants, adrenergicneuron blockers, antineoplastics, immunogenic agents,immunosuppressants, gastrointestinal drugs, diuretics, steroids, lipids,lipopolysaccharides, polysaccharides, and enzymes. It is also intendedthat combinations of bioactive agents may be used.

Anti-adhesive agents can be used to prevent adhesions from formingbetween the implantable medical device and the surrounding tissuesopposite the target tissue. In addition, anti-adhesive agents may beused to prevent adhesions from forming between the coated implantablemedical device and the packaging material. Some examples of these agentsinclude, but are not limited to poly(vinyl pyrrolidone), carboxymethylcellulose, hyaluronic acid, polyethylene oxide, poly vinyl alcohols andcombinations thereof.

Antimicrobial agents may be included as a bioactive agent in thebioactive coating and/or in the film layers of the present disclosure toreinforce the antimicrobial properties of the implant of the presentdisclosure. Suitable antimicrobial agents include triclosan, also knownas 2,4,4′-trichloro-2′-hydroxydiphenyl ether, chlorhexidine and itssalts, including chlorhexidine acetate, chlorhexidine gluconate,chlorhexidine hydrochloride, and chlorhexidine sulfate, biocidequaternary ammonium salts such as dimethyl diallyl ammonium chloride(DADMAC) and its derivatives, silver and its salts, including silveracetate, silver benzoate, silver carbonate, silver citrate, silveriodate, silver iodide, silver lactate, silver laurate, silver nitrate,silver oxide, silver palmitate, silver protein, and silver sulfadiazine,polymyxin, tetracycline, aminoglycosides, such as tobramycin andgentamicin, rifampicin, bacitracin, neomycin, chloramphenicol,miconazole, quinolones such as oxolinic acid, norfloxacin, nalidixicacid, pefloxacin, enoxacin and ciprofloxacin, penicillins such asoxacillin and pipracil, nonoxynol 9, fusidic acid, cephalosporins, andcombinations thereof. In addition, antimicrobial proteins and peptidessuch as bovine lactoferrin and lactoferricin B and antimicrobialpolysaccharides such as fucans and derivatives and oligomers of chitosanmay be included as a bioactive agent in the bioactive coating of thepresent disclosure.

Other bioactive agents which may be included as a bioactive agent in thecoating composition and/or in the film layer composition applied inaccordance include: local anesthetics; non-steroidal antifertilityagents; parasympathomimetic agents; psychotherapeutic agents;tranquilizers; decongestants; sedative hypnotics; steroids;sulfonamides; sympathomimetic agents; vaccines; vitamins; antimalarials;anti-migraine agents; anti-parkinson agents such as L-dopa;anti-spasmodics; anticholinergic agents (e.g. oxybutynin); antitussives;bronchodilators; cardiovascular agents such as coronary vasodilators andnitroglycerin; alkaloids; analgesics; narcotics such as codeine,dihydrocodeinone, meperidine, morphine and the like; non-narcotics suchas salicylates, aspirin, acetaminophen, d-propoxyphene and the like;opioid receptor antagonists, such as naltrexone and naloxone;anti-cancer agents; anti-convulsants; anti-emetics; antihistamines;anti-inflammatory agents such as hormonal agents, hydrocortisone,prednisolone, prednisone, non-hormonal agents, allopurinol,indomethacin, phenylbutazone and the like; prostaglandins and cytotoxicdrugs; estrogens; antibacterials; antibiotics; anti-fungals;anti-virals; anticoagulants; anticonvulsants; antidepressants;antihistamines; and immunological agents.

Other examples of suitable bioactive agents which may be included in thecoating composition and/or in the film layer composition include virusesand cells, peptides, polypeptides and proteins, analogs, muteins, andactive fragments thereof, such as immunoglobulins, antibodies, cytokines(e.g. lymphokines, monokines, chemokines), blood clotting factors,hemopoietic factors, interleukins (IL-2, IL-3, IL-4, IL-6), interferons((3-IFN, (a-IFN and y-IFN), erythropoietin, nucleases, tumor necrosisfactor, colony stimulating factors (e.g., GCSF, GM-CSF, MCSF), insulin,anti-tumor agents and tumor suppressors, blood proteins, gonadotropins(e.g., FSH, LH, CG, etc.), hormones and hormone analogs (e.g., growthhormone), vaccines (e.g., tumoral, bacterial and viral antigens);somatostatin; antigens; blood coagulation factors; growth factors (e.g.,nerve growth factor, insulin-like growth factor); protein inhibitors,protein antagonists, and protein agonists; nucleic acids, such asantisense molecules, DNA and RNA; oligonucleotides; polynucleotides; andribozymes.

Assembling the Implant

In an illustrative embodiment, the implant is prepared by first pouringa solution of collagenic constituent, destined to form a non-porouslayer, such as a film, possibly containing the hydrophilic additive(s)and glycerine, onto an adequate, substantially flat support anddistributing it evenly.

The support is inert in that it does not react with the above-mentionedcomponents and is not involved in the cross-linking process. The supportmay advantageously be made from a hydrophobic material such as, forexample, PVC or polystyrene. However, this support can also consist of astrippable material which will remain slightly adhesive and which canthen be separated from the implant at the time of surgical use. Thissupport may itself also consist of a film, for example dried collagen,onto which the solution is poured, or a layer of collagenic material gelin a distinctly more advanced state of gelification.

The density of the thin layer initially applied as a solution to thesubstrate can be from about 0.1 g solution/cm² to about 0.3 gsolution/cm². This collagenic solution advantageously may be poured at atemperature from about 4° C. to about 30° C., and in embodiments fromabout 18° C. to about 25° C. Once applied to the substrate, the collagensolution is allowed to partially gel. Partial gelling results fromcooling of the collagen solution, and not from drying of the solution.

A mesh reinforcement member is then applied to the solution. Applicationof the reinforcement member onto the solution means simply laying thereinforcement member onto the solution or partially gelled solution, andoptionally applying slight pressing. The pressing should be insufficientto cause any significant disruption of the portion of the layer ofsolution in contact with the support/substrate thereby helping tomaintain the integrity and anti-adhesion characteristics of thenon-porous layer. The pressing may leave the surface of thereinforcement member exposed at the surface of the solution or may embedthe reinforcement member completely within the layer of solution.

Following application of the mesh reinforcement member, but beforecomplete gellification of the initially applied solution, additionalsolution may be applied in an amount sufficient to cover the mesh, sothat it is completely embedded within the solution. Where pressing hasalready embedded the reinforcement member in the solution, applicationof additional solution may be eliminated.

This solution containing the embedded mesh reinforcement member is leftto gel and a porous layer prepared as indicated above is applied to thesolution during gelification.

Application of the porous layer onto the solution during gelificationmeans simply laying the porous layer onto the gel, and optionallyapplying slight pressing. The pressing should be insufficient to causeany significant compaction of the porous layer. In embodiments where theporous layer has been pre-formed, the porous layer will become joined tothe solution, but will not become interlocked with the meshreinforcement member.

The moment at which the porous layer is applied to the solution duringgelification will depend upon the nature of the solution employed, theconditions under which the solution is maintained during gelificationand the nature of the porous layer. Generally, the solution will beallowed to gellify for a period of time prior to application of theporous layer such that the gel is still soft and allows the porous layerto penetrate over a distance which is advantageously from about 0.05 mmto about 2 mm and, in embodiments from about around 0.1 mm to about 0.5mm. The appropriate moment for application of the porous layer for anygiven combination of materials/conditions can be determined empirically,for example by applying small samples of the porous layer to the gel atvarious times and evaluating the degree of penetration and adherence.Generally, when the solution which is gelling is at a temperature ofbetween about 4 and 30° C., the porous layer can be applied from about 5to about 30 minutes after the solution has been poured over the surfaceholding it.

The composite implant is left to dry or dried in order to obtain thefinal implant. When the collagenic solution destined to form the filmincludes oxidized collagen, it is polymerized while the material isdrying. This drying occurs favorably at a temperature of from about 4°C. to about 30° C., in embodiments from about 18° C. to about 25° C. Inother embodiments, the implant is further processed by adding a secondnon-porous layer on the other side, as described above. The material canbe dried in a jet of sterile air if desired.

After drying, the implant can be separated from its support, packagedand sterilized using conventional techniques, e.g., irradiation withbeta (electronic irradiation) or gamma (irradiation using radioactivecobalt) rays. In embodiments where hydrolytically unstable materials areused in forming the composite, such as polyglycolic acid, polylacticacid the composites are packaged under sufficiently dry conditions toensure that no degradation of the composite takes place during storage.

The present implants are stable at ambient temperature and remainsstable for long enough to be handled at temperatures which may rise totemperatures of from about 37 to 40° C. The thickness of the non-porouslayer is not critical, but typically can be less than about 100 μmthick, and in embodiments from about 30 μm to about 75 μm thick.Likewise, the thickness of the porous layer is not critical, buttypically can be from about 0.1 cm to about 1.5 cm thick, and inembodiments from about 0.3 cm to about 1.2 cm thick. The implants inaccordance with this disclosure can be produced at a desired size orproduced in large sheets and cut to sizes appropriate for the envisagedapplication.

The present composites may be implanted using open surgery or in alaparoscopic procedure. When implanted laparoscopically, the compositeimplant should be rolled with the porous side on the inside beforetrocar insertion.

The porous layer of the present implant can act as a long lastingsupport of the repair and/or regeneration of any soft tissues. The highdensity of the porous layer—from about 20 mg/cm³ to about 200mg/cm³—protects the healing wound to some extent from bacteria andmicro-organisms.

On the other hand, the implants described herein are particularlysuitable for preventing post-operative adhesion, particularly inbleeding wounds, because the film prevents adherence. The non-porouslayer also protects the healing wound for several days as it forms abarrier to bacteria and micro-organisms.

In embodiments where a mesh is used as a reinforcement member, the meshwill aid in affixing the composite to tissue without tearing of theporous or non-porous layers. The composite may be affixed to tissueusing any conventional fastener, such as, for example, sutures, staples,tacks, two part fasteners, and the like. In embodiments, the fastenerused to affix the composite to tissue is bioabsorbable, providingsecurement of the composite to a desired location long enough for tissueingrowth to occur.

EXAMPLES

The following non-limiting examples show possible combinations of thematerials and their hemostatic powers and ability to preventpost-operative tissue adhesions.

Example 1

1°) Obtention of Purified Fibers of Collagen

The collagen used is porcine collagen type I, extracted from porcinedermis by solubilization at acidic pH or by digestion with pepsin, andpurified by saline precipitations according to known techniques (see forexample FR-A-2 715 309). Dry collagen fibers obtained by precipitationof an acid solution of such a collagen by adding NaCl, and then washingand drying of the precipitate obtained with aqueous solutions of acetonehaving an increasing concentration of 80% to 100%, are used in thefollowing steps of the present example.

2°) Preparation of Porous Layer

a) Preparation of Glutaraldehyde-Crosslinked Collagen

Purified fibers of collagen obtained in 1°) are solubilized in water ata final concentration of 1% in/v. The solution of collagen at 1% m/v isthen neutralized by adding sodium phosphate at a final concentration of20 mM. The final pH of the suspension was measured at between 6.5 and7.5. Glutaraldehyde (aqueous solution of glutaraldehyde at 25%, m/v,sold by the company Fluka Chemie GmbH, Buchs, Switzerland) is then addedto the suspension at a final concentration of 0.5% m/v. After two hoursat ambient temperature, collagen fibers are recovered by filtration ofthe suspension through a nylon mesh. These fibers are then treated withsodium borohydride for at least two hours until the yellow coloration ofthe fibers has completely disappeared. The white fibers thus obtainedare washed and neutralized at pH 6.5-7.5, and dried by removing thewater with acetone. The acetone residues are then evaporated off.

b) Preparation of Oxidized Collagen

A 30 g/l solution of collagen is prepared by dissolving purified fibersof collagen obtained in 1°) in 0.01 N HCl. Its volume is 49 liters.Periodic acid is added to it at a final concentration of 8 mM, i.e.,1.83 g/l. Oxidation takes place at an ambient temperature close to 22°C. for 3 hours away from light.

Then an equal volume of a solution of sodium chloride is added to thesolution to obtain a final concentration of 41 g/l NaCl.

After waiting for 30 minutes, the precipitate is collected bydecantation through a fabric filter, with a porosity close to 100microns, then washed 4 times with a 41 g/l solution of NaCl in 0.01 NHCl. This produces 19 kg of acid saline precipitate. This washingprocess eliminates all traces of periodic acid or iodine derivativesduring oxidation of the collagen.

Then, several washes in an aqueous solution of 80% acetone are used toconcentrate the collagen precipitate and eliminate the salts present.

A final wash in 100% acetone is used to prepare 3.6 kg of a very denseacetone precipitate of acid, oxidized, non-reticulated collagen, with notrace of undesirable chemical products.

The acetone paste is diluted with apyrogenic distilled water at ambienttemperature, to obtain a 2% concentration of collagen.

c) Preparation of a Composition of Collagen Under the Form of aCollagenic Suspension

A composition under the form of a suspension of collagen is prepared bymixing the glutaraldehyde-crosslinked collagen obtained in a) above andthe oxidized collagen obtained in b) above, at the followingconcentrations:

-   -   0.5 to 3% m/v of glutaraldehyde-crosslinked collagen,    -   0.2 to 2% m/v of oxidized collagen.

d) Preparation of the Porous Layer by Freeze-Drying

The collagen suspension thus obtained in c) above is then lyophilizedaccording to the following method: freezing is carried out as rapidly aspossible, by decreasing the temperature of the product from 8° C. to−45° C., generally in less than 2 hours. Primary desiccation isinitiated at −45° C., at a pressure of from 0.1 to 0.5 mbar. During thisstep, the temperature is gradually increased, with successive slopes andplateau, to +30° C. The lyophilization ends with secondary desiccation,at +30° C., for 1 to 24 hours. The vacuum at the end of secondarydesiccation is between 0.005 and 0.2 mbar. The total lyophilization timeis from 18 to 72 hours.

After the freeze-drying, the porous layer is packed down, in other wordscompressed, so as to reduce its thickness from about 1.2 times to about5 times and so as to give the porous layer a three dimensional densityranging from 20 mg collagen/cm³ to about 200 mg collagen/cm³, either inthe dry or wetted state.

The porous layer may be optionally treated with a solution ofhexamethylene diisocyanate (HMDI) 0.1% w/v in acetone. The treatmentperiod is about 20 hrs. The porous layer is then washed several timeswith acetone. The solvent is then eliminated by evaporation. HMDI may bereplaced by any other suitable cross-linking agent such asglutaraldehyde, isocyanates (eg. isophorone diisocyanate), bifunctionalor trifunctional glycidyl ethers, carbodiimides, acyl azides,divinylsulphone.

In any case, the porous layer is then heated at 50° C. for a periodlasting between 15 and 24 hours to improve the cohesion and mechanicalresistance of the lyophilized product during assembly of the composite.

3°) Preparation of a Solution of Oxidized Collagen Used to Form aNon-Porous Film

Oxidized collagen is prepared as described above in 2°) b) in thisexample, but with minor modifications, at the end of the manufacturingprocess. The acetone paste is diluted with apyrogenic distilled water at40° C., to obtain a 3% concentration of collagen, for a volume of 44liters. The collagen suspension of a volume of 44 liters is heated for30 minutes at 50° C., then filtered under sterile conditions through amembrane of 0.45 micron porosity in a drying oven at 40° C.

As soon as this solution is homogeneous and at 35° C., a sterileconcentrated solution of PEG 4000 (polyethylene glycol with a molecularweight of 4000 Daltons) and glycerine is added to it to produce a finalconcentration of 0.9% PEG, 0.54% glycerine and 2.7% oxidized collagen.

As soon as these additions have been made, the pH of the solution isadjusted to 7.0 by adding a concentrated solution of sodium hydroxide.

4°) Coating of the Reinforcement Member

A knitted isoelastic, multifilament polylactic acid/polyester meshreinforcement member is coated in a solution of type I porcine collagenat 0.8 m/v, by soaking it in the solution, with a padder, machineusually employed in the textile industry for coating process. This cycleof processes is repeated up to three times in order to obtain the fullcovering of the mesh.

At the end of the coating, the collagen deposited on the knit iscross-linked with glutaraldehyde at 0.5% m/v (aqueous solution ofglutaraldehyde at 25%, m/v, sold by the company Fluka Chemie GmbH,Buchs, Switzerland), at neutral pH (pH between 6.5 and 7.5), for 2hours, and is then reduced with sodium borohydride. The reagents usedare removed by washing the knit with several water baths.

The cross-linking of the collagen deposited on the knit canalternatively be carried out at the end of each coating cycle.

5°) Preparation of a Biosynthetic Mesh for Soft Tissue Repair

An implant having a porous layer made from a composition that includes acollagen joined to a fiber-reinforced film made from a composition thatincludes a collagenic constituent is prepared. The collagen solutiondestined to form the non-porous layer, as described in 3°) above, ispoured in a thin layer on a framed, flat hydrophobic support such as PVCor polystyrene, at an ambient temperature close to 22° C. The amount ofsolution used is 0.133 grams of solution per square centimeter ofsupport. The collagen layer is let for about 15 min under a laminar flowhood. Then, the collagen coated reinforcement member obtained in 4°)above is pressed in the gelled collagen layer. The pre-made porous layerobtained in 2°) is then applied and adheres to the still sticky surfaceof the collagen solution.

The composite material is then dehydrated in a drying cabinet at 20° C.and 40% humidity with a horizontal flow of filtered air at a velocity of1.2 m²/s.

An implant is obtained, which is long lasting and resists tearing whenput under moist conditions similar to conditions encountered duringimplantation. In particular, the implant of the present examplemaintains its integrity, its strength and its resistance to tearing evenafter being it soaked in water during 24 hours at ambient temperature(18-25° C.). Such an implant may be used for hernia repair.

Example 2

The product of Example 1 is further processed by adding a secondnon-porous layer on the other side. This second non-porous layerincludes a second reinforcement member.

The collagen solution destined to form the second non-porous layer, asdescribed in above Example 1, part 3°), is poured in a thin layer on aframed, flat hydrophobic support such as PVC or polystyrene, at anambient temperature close to 22° C. The amount of solution used is 0.133grams of solution per square centimeter of support. The collagen layeris let for about 15 min under a laminar flow hood. Then, a secondcollagen coated reinforcement member is pressed in the partially gelledcollagen layer. Finally, the porous layer of the final product ofExample 1 is laid on the partially gelled, second non-porous layer, inwhich the second reinforcement member is embedded.

The composite material is then dehydrated in a drying cabinet at 20° C.and 40% humidity with a horizontal flow of filtered air at a velocity of1.2 m²/s.

An implant is obtained, which is long lasting and resists tearing whenput under moist conditions similar to conditions encountered duringimplantation. In particular, the implant of the present examplemaintains its integrity, its strength and its resistance to tearing evenafter being it soaked in water during 24 hours at ambient temperature(18-25° C.). Such an implant may be used for hernia repair.

Example 3

1°) Preparation of Porous Layer

A composition of a collagen/chitosan mixture was prepared by mixing anacidic solution of oxidized collagen and an acidic solution of chitosanin different proportions with a final polymer concentration of 1% (w/w).

a) Oxidized Collagen

Oxidized collagen was obtained as described in the porous layerdescription of the Example 1, part 2°) b). A 2% w/v solution of oxidizedcollagen was obtained from the collagen paste, at ambient temperature.

b) Chitosan

The chitosan was solubilized in deionized water with a stoechiometricamount of hydrochloric acid with a polymer concentration of 3% (w/w).The pH of the chitosan solution was about 5, but the pH could have beenadjusted to 3 to have better control of the crosslink kinetic betweenthe oxidized collagen and chitosan.

c) Freeze Dried Composite

Several mixtures of various blends of oxidized collagen and chitosan aswell as native collagen and chitosan (approximately 180 g) wereobtained. Optionally, bioactive agents are included, such asantimicrobial agents. To the collagen preparation, may be added glycerolup to 1% w/v. The mixtures were poured within a 12 cm by 17 cm plasticbox and freeze-dried for 48 hours. The samples were then neutralized ina 1M sodium hydroxide bath for 1 hour and thoroughly washed in deionizedwater until the pH reached 7. The freeze-dried sponges were then packeddown, .i.e., compressed, to obtain a porous layer with a final thicknessof 3 mm and a three dimensional density ranging from 20 mg collagen/cm³to about 200 mg collagen/cm³, either in the dry or wetted state.

Additives, such as fucans, oligomers of chitosan, native or chemicallymodified glucosaminoglycans, which may induce self chemical crosslinkbetween collagen and glucosaminoglycans (hyaluronic acid, sulphatechondroitin, etc), oxidized starch, and any other product which mayenhance tissue repair, limit the risk of sepsis, and modulate themechanical properties of the composite (swelling rate in water, tensilestrength, etc) could have been added to the blend of oxidized collagenand chitosan.

The porous layer is then heated at a temperature equal or above 50° C.for a period lasting between 15 and 24 hours to improve the cohesion andmechanical resistance of the lyophilized product during assembly of thecomposite.

2°) Coating of the Reinforcement Member

A knitted isoelastic, multifilament polylactic acid/polyester meshreinforcement member is soaked once, twice, or three times in anoxidized collagen/chitosan mixture with a padder, then dried andneutralized with an alkaline bath so as to cover the accessible surfaceof the mesh yarns. Alternatively, layers of oxidized collagen/chitosanmixture may be neutralized after each soaking cycles.

3°) Preparation of a Biosynthetic Mesh for Soft Tissue Repair

An implant having a porous layer made from a composition that includes across-linked network of oxidized collagen and chitosan joined to afiber-reinforced film made from a composition that includes a collagenicconstituent is prepared. The collagen solution destined to form thenon-porous layer, as described in the Example 1, part 3°), is poured ina thin layer on a framed, flat hydrophobic support such as PVC orpolystyrene, at an ambient temperature close to 22° C. The amount ofsolution used is 0.133 grams of solution per square centimeter ofsupport. The collagen layer is let for about 15 min under a laminar flowhood. Then, the collagen coated reinforcement member as obtained in 2°)above is pressed in the gelled collagen layer. The pre-made, compressedporous layer as obtained in 1°) d) above is then applied and adheres tothe still sticky collagen solution of the non-porous layer exposedthrough the pores of the mesh.

The composite material is then dehydrated in a drying cabinet at 20° C.and 40% humidity with a horizontal flow of filtered air at a velocity of1.2 m²/s.

The composite material may be optionally treated with a solution ofhexamethylene diisocyanate (HMDI) 0.1% w/v in isopropanol. The treatmentperiod is about 20 hrs. The porous layer is then washed several timeswith acetone. The solvent is then eliminated by evaporation.

HMDI may be replaced by any other suitable cross-linking agent such asglutaraldehyde, other isocyanates, bifunctional or trifunctionalglycidyl ethers, carbodiimides, acyl azides, divinylsulphone.

The porous layer can be further heated at about 50° C. for a periodlasting between 15 and 24 hours to improve the cohesion and mechanicalresistance of the lyophilized product during assembly of the composite

An implant is obtained, which is long lasting and resists tearing whenput under moist conditions similar to conditions encountered duringimplantation. In particular, the implant of the present examplemaintains its integrity, its strength and its resistance to tearing evenafter being it soaked in water during 24 hours at ambient temperature(18-25° C.). Such an implant may be used for hernia repair.

Example 4

1°) Collagen Used:

The collagen used are purified fibers of collagen as described inexample 1, part 1°).

2°) Preparation of Porous Layer

a) Preparation of a Composition of Hexamethylene Diisocyanate(HMDI)-Crosslinked Collagen

Fifty grams of dry purified fibers of porcine collagen of 1°) above aremixed with 1 liter of acetone. One gram of HMDI is then added to thecollagen suspension. The mixture is let, under agitation, overnight, atambient temperature. Collagen fibres are then recovered by filtration ofthe suspension through a nylon mesh and are thoroughly washed with dryacetone to remove HMDI and acetone soluble HMDI byproducts. Thecross-linked collagen fibres thus obtained are dried by removing theacetone residues. They may be further ground.

b) Preparation of Oxidized Collagen

Oxidized collagen is prepared from porcine collagen as described inExample 1, part 2°)b).

c) Preparation of the Collagenic Suspension

A composition under the form of a suspension of collagen is prepared bymixing the HMDI-crosslinked collagen of a) above, the oxidized collagenof b) above and, optionally glycerol, at the following concentrations:

-   -   0.5 to 3% w/v of HMDI-crosslinked collagen,    -   0.2 to 2% w/v of oxidized collagen,    -   0 to 1% w/v of glycerol

d) Preparation of the Porous Layer by Freeze-Drying

Several compositions as above in c) under the form of mixtures ofvarious blends of oxidized collagen and HMDI-cross-linked collagen(approximately 180 g) were poured within a 12 cm by 17 cm plastic boxand freeze-dried for 48 hours.

After the freeze-drying, the porous layer is packed down, i.e.,compressed, so as to reduce its thickness from about 1.2 times to about5 times and so as to obtain a three dimensional density ranging from 20mg collagen/cm³ to about 200 mg collagen/cm³, either in the dry orwetted state.

The porous layer may be optionally treated with a solution ofhexamethylene diisocyanate (HMDI) 0.2% w/v in acetone. The treatmentperiod is about 20 hrs. The porous layer is then washed several timeswith acetone. The solvent is then eliminated by evaporation.

HMDI may be replaced by any other suitable cross-linking agent such asglutaraldehyde, isocyanates, bifunctional or trifunctional glycidylethers, carbodiimides, acyl azides, divinylsulphone.

In any case, the porous layer is then heated at a temperature above 50°C. for a period lasting between 15 and 24 hours to improve the cohesionand mechanical resistance of the lyophilized product during assembly ofthe composite.

3°) Coating of the Reinforcement Member

A knitted isoelastic, multifilament polylactic acid/polyester meshreinforcement member is coated in a solution of type I porcine collagenat 0.8% m/v, by soaking it in the solution, with a padder, machineusually employed in the textile industry for coating process. This cycleof processes is repeated up to three times in order to obtain the fullcovering of the mesh.

At the end of the coating, the collagen deposited on the knit iscross-linked with HMDI. The knit is crosslinked in 100 ml of a phosphatebuffer (0.054 M Na₂HPO₄, 0.013 M NaH₂PO₄, pH 7.4) containing 3% (w/w)HMDI and 1.0% (w/w) Tween 80 (polyoxyethylenesorbitan monooleate) as asurfactant for 20 h at room temperature. The knits are then rinsed for30 min by running demineralized water, washed twice for 30 min with 4MNaCl and washed four times for 30 min with distilled water to removeunreacted HMDI or surfactant before drying the knit.

The cross-linking of the collagen deposited on the knit canalternatively be carried out at the end of each coating cycle.

4°) Preparation of a Biosynthetic Mesh for Soft Tissue Repair

An implant having a foam layer (porous layer) made from a compositionthat includes a collagen joined to a fiber-reinforced film made from acomposition that includes a collagenic constituent is prepared. Thecollagen solution destined to form the non-porous layer, as described inthe Example 1, part 3°) is poured in a thin layer on a framed, flathydrophobic support such as PVC or polystyrene, at an ambienttemperature close to 22° C. The amount of solution used is 0.133 gramsof solution per square centimeter of support. The collagen layer is letfor about 15 min under a laminar flow hood. Then, the collagen coatedreinforcement member of 3°) above is pressed in the gelled collagenlayer. The pre-made, compressed porous layer obtained in 2°) above isthen applied and adheres to the still sticky collagen solution exposedthrough the pores of the mesh.

The composite material is then dehydrated in a drying cabinet at 20° C.and 40% humidity with a horizontal flow of filtered air at a velocity of1.2 m²/s.

A second non-porous layer may be further prepared by pouring thecollagen solution as above in a thin layer on a framed, flat hydrophobicsupport such as PVC or polystyrene, at an ambient temperature close to22° C. The amount of solution used is 0.133 grams of solution per squarecentimeter of support. The collagen layer is let for about 15 min undera laminar flow hood. Then, the porous layer of the composite materialobtained above is pressed in the gelled collagen layer.

The resulting material is then dehydrated in a drying cabinet at 20° C.and 40% humidity with a horizontal flow of filtered air at a velocity of1.2 m²/s.

An implant is obtained, which is long lasting and resists tearing whenput under moist conditions similar to conditions encountered duringimplantation. In particular, the implant of the present examplemaintains its integrity, its strength and its resistance to tearing evenafter being it soaked in water during 24 hours at ambient temperature(18-25° C.). Such an implant may be used for hernia repair.

Example 5

The product of Example 1 is further processed by adding a secondnon-porous layer on the other side.

The collagen solution destined to form the second non-porous layer, asdescribed in Example 1, part 3°), is poured in a thin layer on a framed,flat hydrophobic support such as PVC or polystyrene, at an ambienttemperature close to 22° C. The amount of solution used is 0.133 gramsof solution per square centimeter of support. The collagen layer is letfor about 15 min under a laminar flow hood. Then, the porous layer ofthe final product of Example 1 is laid on the partially gelled secondnon-porous layer.

The composite material is then dehydrated in a drying cabinet at 20° C.and 40% humidity with a horizontal flow of filtered air at a velocity of1.2 m²/s.

An implant is obtained, which is long lasting and resists tearing whenput under moist conditions similar to conditions encountered duringimplantation. In particular, the implant of the present examplemaintains its integrity, its strength and its resistance to tearing evenafter being it soaked in water during 24 hours at ambient temperature(18-25° C.). Such an implant may be used for hernia repair.

Example 6

1°) Collagen Used:

The collagen used are purified fibers of collagen as described inexample 1, part 1°).

2°) Preparation of the Porous Layer

a) Preparation of a Composition of HMDI-Crosslinked Collagen

Fifty grams of dry fibers of porcine collagen as obtained in 1°) aboveare mixed with 5 liters of demineralised water, under agitation. Oncethe solution is clear, the collagen is further neutralized andprecipitated with 1N sodium hydroxide solution, at a pH ranging from 6.5to 7.5. The collagen precipitate is collected by centrifugation (10 min,10,000 rpm). The precipitate is washed by 3 successive acetone baths andis then completely dried. The yield of the neutralizing step of collagenis generally over 90%.

Forty grams of dry neutralized collagen is mixed with 0.8 liter ofacetone. Two thousand and four hundred milligrams of HMDI is then addedto the collagen suspension. The mixture is let, under agitation, from 6to 20 hrs, at ambient temperature, under mild agitation. Collagen fibresare then recovered by filtration of the suspension through a nylon meshand are thoroughly washed with dry acetone to remove HMDI and acetonesoluble HMDI byproducts. This HMDI cross-linking step can be repeatedonce or twice. At the end, the cross-linked collagen fibres thusobtained are dried by removing the acetone residues. If needed, they maybe further milled.

A test confirmed that the obtained HMDI cross-linked collagen is notsubstantially degraded by collagenase (Sigma), after 1 day in contactwith collagenase, at +37° C. Generally, the degradation of the obtainedHMDI cross-linked collagen by collagenase is less than 5% of itsoriginal amount whereas 65% or more of non cross-linked collagen isdegraded in the very same conditions of the collagenase test.

b) Preparation of Oxidized Collagen

Oxidized collagen is prepared from purified fibers of porcine collagenas described in the Example 1, part 2°) b).

c) Preparation of a Composition Under the Form of a CollagenicSuspension

A suspension of collagen is prepared by mixing the HMDI-cross-linkedcollagen of a) above, and the oxidized collagen of b) above, at thefollowing concentrations:

-   -   0.7 to 3% w/v of HMDI cross-linked collagen,    -   0.2 to 1.5% w/v of oxidized collagen.

d) Preparation of the Porous Layer by Freeze-Drying

Several compositions as above in c), under the form of mixtures ofvarious blends of oxidized collagen and HMDI-cross-linked collagen(approximately 180 g) were poured within a 12 cm×17 cm plastic box andfreeze-dried for 48 hrs.

After the freeze-drying, the porous layer is further packed down, iecompressed, with a press at a pressure between about 2 and about 12bars, for a time ranging from 1 s to 20 s (Mader Pressen) and/or with anisostatic press (ACB, France), at a pressure between about 1,000 andabout 1,500 bars, from about 1 minute to about 5 minutes, so as toreduce its thickness from about 1.5 to about 5 times, so as to get afinal three dimensional collagen density ranging from about 50 mg/cm³ toabout 200 mg/cm³, either in a dry or wetted state.

Ten grams of the porous layer is further neutralized in one liter ofisopropanollethanol (95/5, v/v) containing from about 20 μmol to about70 μmol of sodium hydroxide. The alcohol mixture is further removed byseveral washings with acetone. The porous layer is then treated with asolution of HMDI at a concentration of collagen of 50 grams per literand at a concentration of HMDI ranging from about 0.1% to about 3% w/v.The mixture is let, under agitation, from 6 to 20 hrs, at ambienttemperature, under mild agitation. The porous layer is then recovered byfiltration removing acetone and is thoroughly washed with dry acetone toremove HMDI and acetone soluble HMDI byproducts. This HMDI cross-linkingstep can be repeated once or twice. At the end, the porous layer thusobtained is dried by removing the acetone residues.

A test has shown that the thus obtained porous layer is notsubstantially degraded by collagenase (Sigma), after 1 day in contactwith collagenase, at +37° C. Generally, the degradation of the obtainedHMDI cross-linked collagen by collagenase is less than 5% of itsoriginal amount whereas 65% or more of non cross-linked collagen isdegraded in the very same conditions of the collagenase test.

3°) Coating of the Reinforcement Member

The coating reinforcement member is prepared as described in the Example1, part 4°).

4°) Preparation of a Biosynthetic Mesh for Soft Tissue Repair

The biosynthetic mesh for soft tissue repair is prepared as described inExample 1, part 5°).

Example 7

1°) Preparation of a Biosynthetic Implant

A porous later has been prepared as described in the Example 6. Thecollagenic suspension is prepared by mixing theglutaraldehyde-cross-linked collagen and the oxidized collagen asobtained above in Example 6, at the following concentration:

-   -   1.125% m/v of glutaraldehyde-cross-linked collagen,    -   0.375% m/v of oxidized collagen.

Two hundreds and forty grams of this collagen suspension were pouredwithin a 12 cm by 17 cm plastic box and freeze-dried for 48 hrs.

After the freeze-drying, the obtained porous layer was packed down,i.e., compressed, with the mechanical press (Mäger pressen) at 4 barsduring two seconds and further packed down with the isostatic press(ACB, France) at 1,000 bars during 1 minute and then at 1,300 barsduring 2 minutes.

The porous layer (50 grams) has been further treated with 1 liter ofsolution of HMDI at the concentration of 3% w/v in acetone, during 1day. Then, the porous layer was extensively washed with acetone forremoving HMDI and HMDI byproducts. The HMDI cross-linking step wasrepeated twice. At the end, the acetone was eliminated by evaporation.

The final thickness of the porous layer was about 1.5 mm with acorresponding three dimensional density of collagen at about 110 mg/cm³,either in a dry or wetted state.

The obtained porous layer was then further assembled with a coatedreinforcement member, the reinforcement member being an isoelasticpolyester mesh available under the tradename Parietex® C, from thecompany Sofradim, and showing a weight density of about 110 g/m². TheParietex® C mesh was coated as described in Example 1, part 4°).

2°) Full Thickness Abdominal Wall Defect

A full thickness abdominal wall defect model has been designed in ratfor the evaluation of the biosynthetic implants of the present Example.The surgery consisted in creating a 1.5×3.0 cm full defect of thelateral anterior parietal wall (fascia, muscle and peritoneum). Thedefect was covered with a 2.0×3.5 cm implant. On FIG. 10 are shownschematically the llinea alba 100, the skin 101 and the abdominalmuscles 102 of a rat.

As a prophylactic measure the rats received a pre-operative subcutaneousinjections of carprofene (Pfizer) and enrofloxacine (Bayer). The abdomenwas clipped free of fur. The skin was scrubbed and painted with povidoneiodine (Vetoquinol). With reference to FIG. 10, a medial incision of theabdominal skin 101 was performed. The left external surface of theabdominal wall was exposed. A full thickness 1.5×3 cm square defect 103was created within the abdominal musculature 102. The peritoneum wasremoved together with the abdominal muscular layer. One defect 103 wascreated per animal. Each defect 103 was covered with an approximately2×3.5 cm square implant 104 obtained in 1°) above, as depicted on FIG.10. One product/implant 104 was implanted per animal, with smooth sideon the flank of the abdominal cavity. The product was sutured usingabsorbable sutures 105 (such as Monocryl 4-0, Ethicon, France). The skin101 was closed by continuous intracutaneous absorbable sutures (Mersilk1 4Ph., Ethicon, France). A dressing was applied on the abdomen.

Macroscopic and microscopic observations of the implants were made at 2weeks and 4 weeks. They showed the nice integration of the implant,fully covering the defect, starting to be cell colonized in its fullthickness. No obvious signs of herniation, in particular at the edges ofthe implant in the abdominal wall were noticed. No significantdegradation of the implant, in particular the mesh itself and the porouslayer, was as well observed, even after 4 weeks,

It was noticed, even after 4 weeks of implantation, that the implant wasnot delaminated, for example having the mesh fully detached from theporous layer.

Example 8

The implant of EXAMPLE 7 was repeated, wherein the polyester Parietex® Cmesh was replaced by an isoelastic polypropylene mesh available underthe tradename Parietene® PPL from the company Sofradim and having aweight density of about 40 g/m².

Example 9

The implant of EXAMPLE 7 was repeated, wherein the polyester Parietex® Cmesh was replaced by an isoelastic polyester mesh available under thetradename Parietex® CL from the company Sofradim and having a weightdensity of about 60 g/m².

Example 10

1°) Preparation of Porous Layers

The porous layers have been prepared as described in the Example 6. Thecollagenic suspension is prepared by mixing theglutaraldehyde-cross-linked collagen and the oxidized collagen obtainedin Example 6 above, at the following concentrations:

Products A & B

-   -   1.125% m/v of glutaraldehyde-cross-linked collagen,    -   0.375% m/v of oxidized collagen.

A first product, the product A, was prepared by pouring one hundred andeighty grams of this collagen suspension within a 12 cm by 17 cm plasticbox and freeze-dried for 48 hrs. After the freeze-drying, the obtainedporous layer was packed down with the isostatic press (ACB, France) at1,000 bars during 1 minute and then at 1,300 bars during 2 minutes. Ithas been packed in sealed aluminium I PET pouches, and further stored inan oven, at +103° C., during 1 day. It was then gamma-irradiated at adose between 25 and 45 kGy and further heated at +50° C., during 2 days.

The final thickness of the porous layer was about 1.1 mm with acorresponding three dimensional density of collagen at about 135 mg/cm³,after its soaking in water during 24 hrs, at ambient temperature, i.e.,in the wetted state of the porous layer.

A second product, the product B, was prepared by pouring two hundredsand forty grams of this collagen suspension within a 12 cm by 17 cmplastic box and freeze-dried for 48 hrs. After the freeze-drying, theobtained porous layer was packed down with the isostatic press (ACB,France) at 1,000 bars during 1 minute and then at 1,300 bars during 2minutes. About 50 grams of the thus obtained porous layer has beenfurther treated with 1 liter of solution of HMDI at the concentration of3% w/v in acetone, during 1 day. Then, the porous layer was extensivelywashed with acetone for removing HMDI and HMDI byproducts. At the end,the acetone was eliminated by evaporation. It has been packed in sealedaluminium/PET pouches, and further stored in an oven, at +103° C.,during 1 day. It was then gamma-irradiated at a dose between 25 and 45kGy and further heated at +50° C., during 2 days.

The final thickness of the porous layer was about 0.9 mm with acorresponding three dimensional density of collagen at about 125 mg/cm³,after its soaking in water during 24 hrs, at ambient temperature, ie ina wetted state of the porous layer.

2°) Sub-Cutaneous Implantation of the Porous Layers A & B, in Rats

The sterile porous layers A & B, obtained as described above, wereavailable as 10×20 mm pieces which were subcutaneously implanted inrats. The rats were sacrificed at 2, 4 and 12 weeks, after theimplantation of the porous layers (three animals per time period withthree sites per article and per time period). Macroscopic andhistological observations have been performed for the evaluation of theimplanted porous layers, in particular, for the evaluation of the localtolerance, the cellular or tissular colonization and implantdegradation.

The study was based on the ISO10993 standard: Biological evaluation ofmedical devices, Part 6 (2007): Tests for local effects afterimplantation.

There was no evidence of morbidity or mortality during the study. Noclinical abnormalities were detected during the course of the study. Theporous layers A & B behaved in a similar way. At 2 weeks, the productswere moderately integrated into the surrounding tissues with a moderategrade of cells and tissue colonization. A moderate grade of inflammationreaction was observed and products were slightly degraded by phagocyticcells. Very similar findings were observed at 4 weeks as compared to the2 week time period with no fibrin and collagen deposit within theproducts, even if the product A showed better signs of colonization andintegration. No significant increase of biodegradation was observed. At12 weeks, very similar findings were also observed as compared to theprevious time points (2 & 4 weeks), but with better tissue integrationand cell colonization within the full thickness of the porous layers.The porous layers were slightly degraded with better resistance todegradation for the porous layer A.

At 2, 4 & 12 weeks, the initial thickness of the porous layers—asdetermined in a wet state, after the soaking of porous layers in waterfor 24 hours, at ambient temperature (18-25° C.), during 1 day—was notsubstantially reduced.

In conclusion, the local tolerance was good for the porous layers A& Bwith extended degradation times and with satisfying signs of cellcolonization and integration of the porous layers.

It will be understood that various modifications may be made to theembodiments disclosed herein. Therefore, the above description shouldnot be construed as limiting, but merely as an exemplification ofillustrative embodiments. Those skilled in the art will envision othermodifications within the scope and spirit of the present disclosure.Such modifications and variations are intended to come within the scopeof the following claims.

What is claimed is:
 1. A process for preparing an implant having aporous layer, a non-porous layer and a reinforcement member comprising:preparing a composition comprising collagen, using purified fibers ofcollagen as starting material; freeze drying the prepared composition toobtain a porous layer, compressing the porous layer to obtain a threedimensional density ranging from about 20 mg collagen/cm3 to about 200mg collagen/cm3; pouring a solution of a collagenic constituent onto asupport to obtain a non-porous layer; applying a reinforcement member ona top surface of the non-porous layer, and applying the compressedporous layer on the top surface of the non-porous layer, duringgelification of the non-porous layer.
 2. The process of claim 1, whereinthe three dimensional density of the compressed porous layer ranges fromabout 50 mg collagen/cm3 to about 150 mg collagen/cm3.
 3. The process ofclaim 1, wherein the collagen of the porous layer comprises oxidizedcollagen.
 4. The process of claim 3, wherein the collagen of the porouslayer further comprises a collagen crosslinked with a compound selectedfrom glutaraldehyde, hexamethylene diisocyanate (HMDI) and mixturesthereof.
 5. The process of claim 3, wherein the collagen of the porouslayer further comprises a chitosan.
 6. The process of claim 1, whereinthe collagenic constituent of the non-porous layer is obtained frompurified fibers of collagen used as starting material.
 7. The process ofclaim 1, wherein applying the reinforcement member on the top surface ofthe non-porous layer further includes pressing the reinforcement memberinto the solution of the non-porous layer, without causing significantdisruption of the portion of the layer of solution in contact with thesupport, so as to embed the reinforcement member completely within thenon-porous layer.
 8. The process of claim 1, further comprising applyingadditional solution of the collagenic constituent after applying thereinforcement member on the top surface of the non-porous layer, in anamount sufficient to cover the reinforcement member, so as to embed thereinforcement member completely within the non-porous layer.
 9. Theprocess according to of claim 1, wherein compressing the porous layerreduces the thickness of the porous layer by about 1.2 times to 5 times.10. The process according to of claim 1, wherein the compressed porouslayer has a thickness ranging from about 0.1 cm to 1.5 cm.
 11. Theprocess of claim 1, wherein the reinforcement member is a mesh having aweight density less than 100 g/m2.
 12. The process of claim 11, whereinthe mesh is isoelastic.
 13. The process of claim 1, wherein thereinforcement member is a mesh having a weight density greater than 50g/m2.
 14. The process of claim 13, wherein the mesh is asymmetric. 15.The process of claim 13, further comprising coating the mesh with acollagenic coating.
 16. The process of claim 15, wherein the collageniccoating comprises collagen crosslinked with a compound selected fromglutaraldehyde, hexamethylene diisocyanate (HMDI) and mixtures thereof.17. The process of claim 15, wherein the collagenic coating comprises amixture of oxidized collagen and chitosan.
 18. The process of claim 1,further comprising adding an additional non-porous layer.
 19. Theprocess of claim 18, wherein the additional non-porous layer comprisesan additional reinforcement member embedded therein.
 20. The process ofclaim 19, wherein the reinforcement member is coated and the additionalreinforcement member is uncoated.
 21. A process for preparing an implanthaving a porous layer, a non-porous layer and a reinforcement membercomprising: freeze drying a composition comprising collagen to obtain aporous layer, compressing the porous layer to obtain a three dimensionaldensity ranging from about 20 mg collagen/cm3 to about 200 mgcollagen/cm3; pouring a solution of a collagenic constituent onto asupport to obtain a non-porous layer; applying a reinforcement member ona top surface of the non-porous layer, and applying the compressedporous layer on the top surface of the non-porous layer, duringgelification of the non-porous layer.